Abstract

SA.16.06

Clinical theoretical substantiation of microinvasivenon-penetrating deep sclerectomy (MNPDS) in surgery of open-angle glaucoma

Takhchidi K. P., Khodjaev N. S., Bessarabov A. N., Takhchidi E. K.
S.N. Fyodorov Eye Microsurgery State Institution
Presenter: Dr. A. Zahidov

Objective: One of trends in struggle against excessive cicatrisation is reduction of surgical trauma volume. Microinvasive non-penetrating deep sclerectomy (K.P. Takhchidi, 1999) was offered for this purpose.
Aim: Determination of optical sizes for surgical filtration zone which allow to achieve IOP of necessary level using mathematical modeling of eye hydrodynamics.
Methods: In process of mathematical modeling the features of aqueous humor outflow through the TDM zone surgically formed and intact part of trabecula were studied on the basis of mathematical laws of hydrodynamics and eye biomechanics. It was determined that optimal sizes of filtration zone surgically formed for ophthalmotonus normalization ranged 1.2-3.0 mm.
In clinic 45 eyes (30 patients) with open-angle glaucoma were examined and operated. The intrascleral interface sizes was in the range 1.2-3.0 mm. Mean IOP: 32±3 mmHg. Follow-up: up to 18 months after MNPDS. Evaluation of outflow pathway functionality was performed using standard examinations including UBM and B-scanning
Results: Dynamic investigations showed IOP normalization in 92% of cases, stable hypotensive effect within entire follow-up, average IOP 16-18mmHg. Bio-microscopically filtering bleb had moderate thickness with small quantity of vessels, thinned – 6.5%, flat – 6.5%. UBM data was evidence for competence of outflow pathways surgically formed in 42 eyes (91.3%). No case of intra- and post-operative choroidal complications was noted.
Conclusions: Thus, range of minimal parameters (1.2-3.0 mm) was determined to achieve adequate hypotensive effect based on mathematical modeling; clinical follow-up up to 18 months demonstrated high and stable hypotensive MNPDS effect.

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